Acute Abdomen

Ira Shah
Consultant Pediatrician, B.J.Wadia Hospital for Children, Mumbai, India
First Created: 02/23/2001 

Introduction

Abdominal pain is one of the most common presentations in the pediatric emergency department. The most important concern is to decide if the condition requires surgical intervention or can be managed medically.

What is important is to note whether the pain is constant or colicky and the site and radiation of the pain. Also, other associated features such as nausea, vomiting, bowel or urinary complaints, vaginal bleeding aid in the diagnosis. Clinical examination findings such as the presence of fever, tenderness, rigidity (indicates peritoneal inflammation), organomegaly, increased/decreased bowel sounds, pallor, jaundice usually help to determine the cause of pain.

Causes of Acute Abdomen

In first few years of life:

  • Congenital abnormalities

  • Incarcerated inguinal hernia

  • Intussuception

  • Intestinal volvulus

  • GI perforation

  • NEC in preterm neonates

In older children:

  • Trauma

  • Pancreatitis

  • Meckel's diverticulum

  • Primary peritonitis

  • Intestinal worm infestation

In adolescents:

  • Acute appendicitis

  • Cholecystitis (acalculous)

  • Testicular torsion

  • Rupture of ovarian cyst

Non- surgical causes of abdominal pain:

  • Hyperthyroidism

  • Addison's disease

  • Diabetic ketoacidosis

  • Hypercalcemia

  • Lead poisoning

  • Porphyria

Non-specific abdominal pain

It is the most common cause of abdominal pain in late childhood and early adolescence. It is a colicky pain with some localization that becomes worse after meals. Bowel sounds may be increased and a palpable mass of feces may be present in right or left iliac fossa. The causes commonly are constipation, irritable bowel, and chronic spasm.

The treatment consists of antispasmodics.

Investigations

  • Abdominal X-Ray/Chest X-Ray erect: Look for bowel obstruction calcification, free air and lower lobe pneumonia. Also soft tissue mass may be seen

  • Ultrasound of both pelvis and upper abdomen: For hepatobiliary, renal and gynaecological pathology

  • Complete blood count: Increased in case of necrosis, bacterial infection, abscess.

  • Peripheral smear for HUS, Sickle cell.

  • Urine examination for UTI, porphyria

Additional investigations

  • Serum Amylase/lipase: for pancreatitis

  • Blood cultures

  • Beta HCG

  • CT scan for abdomen

  • Stool examination for worm infestation

Management of Acute Abdomen

Along with the treatment of specific conditions, patients may require intravenous fluids, antibiotics, and antispasmodics. The commonly used antibiotics are ampicillin (100 mg/kg/d), gentamicin (5 mg/kg/d), clindamycin (40 mg/kg/d) or metronidazole (30 mg/kg/d). Other antibiotics such as third-generation cephalosporins are also useful. Surgical treatment would depend on the presenting cause.


Acute Abdomen Acute Abdomen Acute Abdomen 02/23/2001
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